“Bloodborne Pathogens” for Nursing Education Teachers

TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development.

Hepatitis and HIV

Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Viruses which attacks the liver Liver performs many functions vital to life Blood reservoir, blood filter, carbohydrate, fat, protein metabolism, storage of vitamins, iron, etc.

Hepatitis A Caused by infection with Hepatitis A virus NOT BLOODBORNE Virus is found in the stool of infected persons HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A Occurs in epidemics both nationwide and in communities

Hepatitis A--Symptoms Jaundice Fatigue Abdominal pain Loss of appetite Nausea Diarrhea Fever

Hepatitis A Prevention Good personal hygiene and proper sanitation can help prevent hepatitis A Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food Vaccine is available

Hepatitis B Caused by infection with Hepatitis B virus IS BLOODBORNE Occurs when blood or body fluids from an infected person enters the body of a person who is not immune  HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission) by sharing drugs, needles, or "works" when "shooting" drugs from an infected mother to her baby during birth through needlesticks, sharps exposures, blood splashes on the job, Can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death

Hepatitis B Symptoms Jaundice Fatigue Abdominal pain Loss of appetite Nausea, vomiting  Joint pain

Hepatitis B--Prevention A safe and effective vaccine is available Use latex condoms correctly and every time you have sex. (The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.) If you are pregnant, get a blood test for hepatitis B; Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth. Never share drugs, needles, syringes, or "works“ Do not share personal care items that might have blood on them (razors, toothbrushes) At work, do not come into contact with another person’s blood or body fluids

Hepatitis C Hepatitis C is a disease of the liver caused by the Hepatitis C virus (HCV) IS BLOODBORNE Occurs when blood or body fluids from an infected person enters the body of a person who is not infected  HCV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission) by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks, sharps exposures, blood splashes on the job, or from an infected mother to her baby during birth through needlesticks, sharps exposures, blood splashes on the job, Chronic infection: 55%-85% of infected persons Chronic liver disease: 70% of chronically infected persons Leading indication for liver transplant

Hepatitis C--Symptoms Jaundice Fatigue Dark urine Abdominal pain  Loss of appetite Nausea 80% of infected persons have no signs or symptoms

Hepatitis C--Prevention There is no vaccine to prevent hepatitis C Do not shoot drugs and never share needles, syringes, or "works" Do not share personal care items that might have blood on them (razors, toothbrushes) At work, do not come into contact with another person’s blood or body fluids

Hepatitis D Hepatitis D is a liver disease caused by the hepatitis D virus (HDV) It is a defective virus that needs the hepatitis B virus to exist

Hepatitis E Hepatitis E is a liver disease caused by the hepatitis E virus (HEV) NOT BLOODBORNE It is transmitted in much the same way as hepatitis A virus Hepatitis E does not occur often in the United States

Viral Hepatitis - Overview Type of Hepatitis A B C D E Source of feces blood/ blood/ blood/ feces virus blood-derived blood-derived blood-derived body fluids body fluids body fluids Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral transmission permucosal permucosal permucosal Chronic no yes yes yes no infection Prevention pre/post- pre/post- blood donor pre/post- ensure safe exposure exposure screening; exposure drinking immunization immunization risk behavior immunization; water modification risk behavior modification 3

HIV Human immunodeficiency virus HIV can be passed from person to person if someone with HIV infection has sex with or shares drug injection needles with another person It also can be passed from a mother to her baby when she is pregnant, when she delivers the baby, or if she breast-feeds her baby Leads to disease AIDS Destroys the immune system

HIV Symptoms The symptoms are similar to the symptoms of many other illnesses You might have HIV and still feel perfectly healthy The only way to know for sure if you are infected or not is to be tested

HIV Prevention Don’t share needles and syringes used to inject drugs, steroids, vitamins, or for tattooing or body piercing Don’t share equipment ("works") used to prepare drugs to be injected Use a latex condom to reduce the risk of STD transmission. Don’t share razors or toothbrushes because of the possibility of contact with blood If you are pregnant or think you might be soon, talk to a doctor or your local health department about being tested for HIV. Drug treatments are available to help you and reduce the chance of passing HIV to your baby if you have it At work, do not come into contact with another person’s blood or body fluids

You Do Not Get Hepatitis B, C, or HIV By working with or being around someone who has the disease From sweat, spit, tears, clothes, drinking fountains, phones, toilet seats, or through everyday things like sharing a meal From insect bites or stings From donating blood From a closed-mouth kiss (but there is a very small chance of getting it from open-mouthed or "French" kissing with an infected person because of possible blood contact)

Bloodborne Pathogens (BBPs) Pathogenic micro- organisms present in human blood that can lead to diseases Human immuno- deficiency virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV) I. Background for the Trainer: Pathogens are disease-producing bacteria or microorganisms. II. Speaker’s Notes: OSHA defines bloodborne pathogens as pathogenic microorganisms present in human blood that can lead to diseases. There are many disease-causing pathogenic microorganisms that are covered by this Standard; however, the most common and those of primary concern are: Human immunodeficiency virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV)

Other Bloodborne Pathogens Syphilis Malaria Brucellosis Babeosis Leptospirosis Arborviral Infections Relapsing Fever Creutzfeld-Jacobs Disease--Mad-cow Viral Hemorrahgic Fever--Ebola

Universal Precautions Must be observed All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc. Do not come into contact with another person's blood or body fluids

Potentially Infectious Materials-- Any visibly contaminated body fluid Any body fluid where differentiation is difficult Any unfixed tissue or organ Aqueous and vitreous humors in the eyes Blood Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental proc.

Other Body Fluids These body fluids do NOT have enough virus in them to transmit disease UNLESS they are contaminated with blood Urine Feces Tears Sweat Vomitus Spit

Splash to Mucous Membranes Modes of Transmission Non-Intact Skin Stick or Cut Splash to Mucous Membranes

Exposure Control Plan Employer's plan describing how compliance with the standard is achieved Describes what employees are covered Describes tasks that are covered Describes post-exposure follow-up procedures Must be reviewed and updated annually Must be accessible to employees Everyone should know the procedure to follow to obtain a copy

Handwashing The single most important aspect of infection control Wash hands when contaminated with blood or body fluids and after removing gloves Use antiseptic hand cleaner clean paper/cloth towels or antiseptic towelettes when "in the field" Wash hand with soap and water asap

Needles/Sharp Objects Use sharps with sharps injury prevention or needleless systems Place in puncture resistant, labeled, leak-proof containers for transport, storage, and/or disposal Keep the container closed Do not bend, break, recap, or remove needles Do not pick up contaminated broken glass directly with the hands Do not reach by hand into containers where contaminated sharps are placed

Eating/Drinking Do not eat or drink in areas where there is exposure to blood or body fluids Do not store food in refrigerators, freezers, cabinets, on shelves or countertops where blood or other body fluids are present

Personal Protective Equipment (PPE) Wear PPE to prevent blood or body fluids from getting on your clothes, skin, underclothes, etc. Must be provided at no cost to the employee Employer must enforce the use Must be removed prior to leaving the work area and placed in designated area

PPE Parental exposure Mucous membrane Non-intact skin stick or cut splash Non-intact skin spill or splash

Decontamination Clean and decontaminate all equipment and environmental and working surfaces after contact with blood and/or body fluids Decontaminate with appropriate disinfectant EPA registered tuberculocidal disinfectant EPA registered disinfectant with label stating it is effective against HIV and HBV Household bleach, diluted 1:10-1:100, made fresh daily

Contaminated Laundry Remove contaminated clothing when it becomes contaminated Place immediately in bag or container that is labeled Prevent leakage

Hepatitis B Vaccination Your employer must offer you the HBV vaccination after you have received training and within 10 working days of job assignment At no cost Provided by PLHCP According to US Public Health Service most current recommendations “Immunization of Health Care Workers: Recommendations of ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

HBV Vaccination Sign a declination statement if do not want to take the shots Highly recommended Few contraindications Three-shot series No booster currently recommended Each employee should be given a health care professional’s written opinion as to whether it is safe for YOU to take the shots and whether or not you did Can decline now, take the shots later

Post-Exposure Follow-up After exposure incident Stick or cut Splash Non-intact skin exposure At no cost Begin ASAP after exposure incident Report exposure incident to your supervisor or designated personnel immediately

Post-Exposure Follow-up Investigation of the incident ID source individual, obtain consent, and test their blood to determine HBV, HCV, and HIV infectivity ASAP Results of source individual's test given to exposed person Obtain and test exposed person's blood for HBV, HCV, and HIV serological status

Post-Exposure Follow-up Post-exposure prophylaxis as indicated by CDC Counseling Evaluation of reported illnesses According to U.S. Public Health Service Guidelines HIV--“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” September 30, 2005, Vol 54, RR-09 HBV, HCV--“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis” June 29, 2001, Vol 50, No. RR-11

Written Opinion Employee will be provided a copy of the Health Care Professional's Written Opinion for Post-Exposure Follow-up within 15 days of completion of the evaluation

Labels Containers with contaminated items Can substitute red

Training Before exposure Annually At no cost

Records Medical records Name and social security number HBV vaccination status Results of exposure incident follow-up Health care professional's written opinions Info provided to health care professional Confidential

Records Training Dates Contents Names and qualifications of trainers Names and titles of persons attending

What’s Wrong Here?

Resources www.osha.gov www.tennessee.gov/labor-wfd/tosha www.cdc.gov www.cdc.gov/niosh Memphis Office 901-543-7259 Jackson Office 731-423-5641 Nashville Office 615-741-2793 1-800-249-8510 Knoxville Office 865-594-6180 Kingsport Office 423-224-2042 Chattanooga 423-634-6424 Consultative Services 1-800-325-9901